Which of the following best describes an intrinsic plus position?

• A. MCP extension, IP extension
• B. MCP flexion, IP flexion
• C. MCP flexion, IP extension
• D. MCP extension, IP flexion

Answer: (D)

Intrinsic plus is the hand posture where the metacarpophalangeal joints are extended while the interphalangeal joints are flexed. This arrangement keeps the intrinsic muscles (interossei and lumbricals) in a favorable length-tension relationship and maintains the integrity of the collateral ligaments at the MCP joints, helping to prevent contractures and preserve tendon glide. It’s commonly used in rehab and splinting after injury or burns because it supports a functional, safe resting position for the hand.

Choosing a position with MCP extension and IP flexion best matches this concept, while other combinations place the joints in states that don’t optimize the intrinsic muscles and ligaments in the same way.